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Archive for April, 2009

To introduce myself, I’m currently serving as the medical director for Rising Star Outreach (RSO) in India. Chad has asked that I post something about what I”ve been doing over the past 8 months. It’s very difficult to know where to start, but I’m going to give it a shot and then follow-up with more, depending on the questions that follow. I have no special training in tropical medicine or public health, just a long-standing desire to be involved in improving the health care for those most in need. So, I’ll be happy to hear from others with more experience and/or training who have suggestions and comments. I am a family-medicine trained physician and spent the first four years of my career as the physician of a rural Community Health Center in Na’alehu Hawaii. After that, my wife and I felt it was time to do what we’d always said we’d do – find an organization who needed our services in a developing nation. Through Chad, we discovered a need with Rising Star that fit perfectly with our skills and desires. Rising Star Outreach exists to try to assist those who have been afffected by leprosy (although I’m aware that the term Hanson’s disease is preferred among some, I’ll continue to use the term leprosy in this posting because it is the term commonly used here in India). While I work on the medical side of the organization, my wife (who has an education background) assists at the school.

In India, RSO runs a mobile clinic in an attempt to improve the healthcare for the seven colonies it services. At the same time, RSO administers microloans to leprosy afflicted infividuals and offers a boarding school to some of the children from the colonies. I live with my wife and 3 small children on the rural RSO property which also houses the children’s hostels and school. My responsibilities include overseeing the mobile clinic and medical services on site for the children (and other employees). I work closely with a local physician, who is trained as a general practicioner, and a local nurse.

In India, the rates of new leprosy cases are very low. The Indian government and the WHO have made huge efforts to encourage early detection and treatment which are now paying off. The patients whom I treat are not people with active leprosy, but rather people who acquired the disease many years ago, did not receive prompt treatment, and now suffer various disabilities because of it. Because of the nerve damage that has taken place, many of the patients suffer from chronic ulcers, primarily on their lower extremeties. One of our big goals has been to try to find a better way to help these wounds heal. Having done a little extra training in woundcare before arriving, I had certain ideas about what needed to be done to improve healing. However, I soon realized the difficulty in transferring these techniques – the main barriers were lack of similar materials and also the low frequency of our visits.

About a year ago, I was introduced to a surgeon from Mumbai, Dr. Atul Shah, who was holding “camps” to help similarly afflicted individuals treat their wounds. He was giving instruction sessions and handing out small packets with a callous file, bandages, antisceptic, and antibiotic ointment. He was reporting good results through this self-care program. At first I was a little skeptical that this could really have the impact I was looking for, but after several months of treating these patients with little success, I began to see the wisdom in this program. With it’s focus firmly on self-reliance, it fits in well with our efforts to educate the children of the colonies and encourage financial independence.

So, in January, we put together our own self-care kits, and started rolling out this program to the seven colonies we visit. Each colony is visited every 2 weeks. In the past these visits included consultation with the physician and the dispensing of basic medications for general problems as well as bandage changes for those in need. We also provide transportation to a private hospital in Chennai, Sri Ramachandra Medical Center, two or three times a month for patients needing specialty care, procedures, or hospitalization. (This gives them another option for care outside of the government system.) Now, in addition to the other services provided, we meet individually with each patient to assess their wounds which we are following with digital photos. It allows us to provide specific encouragement and reinstruction as they look at their initial photo on our laptop and view the current wound. We’re currently midway through what should be a 4 month program in several of the colonies, with the larger of our 2 colonies being about a month into it. It’s been very exciting to discover that many of the patients are making very good progress, while I saw very little progress in the months before the program. To me, this is a great example of the effectiveness of a simple program that places responsibility with the patients. Clinically, I believe the program is working because it encourages a gradual removal of old deep callous (through soaking the feet and using the callous file) so that it can be replaced with more viable tissue, and it simply encourages more regular care of the wounds.

In addition to the work in the colonies, caring for the medical needs of the 125 boarding students has been a treat. They are a fun group of children who always pose the challenge of figuring out whether they have a serious medical problem that day or just want a little more attention. Thus far, we’ve avoided anything catastrophic, although we’ve had our share of fractures, lacerations, common pediatric infections, and single cases of scopion envenomation, slipped capital femoral epiphysis, and clinically significant Hepatitis A, and Typhoid fever. We’ve begun a program, with the kind help of a local pediatrician, to provide immunizations to the children which are not on the government schedule (next up is Typhoid) which I’m very pleased with. Dr. Jayakumar drives about 40 minutes and provides staff and vaccinnes each month to assist us in this project. We became acquainted when I started taking my own son to him for his 1-year vaccinations.

So, overall, this has been a wonderful experience for me. I have no delusions that the service I offer is any greater than the growth I’m gaining through the medical experiences I’m having as well as the personal growth that comes with service. Hopefully, with the help of others, this can be one step toward increasingly more effective interventions as we strive to assist those with the greatest medical needs.

On another note, RSO is very interested in keeping a health-care professional on campus once I leave. I will be coming back to Utah in May. While the local physician and nurse will still be running the medical services, they live about 40 minutes from campus. To manage the urgent, or potentially emergent, problems that arise with the children and employees, RSO would like to keep a healt-care provider on site. This could be a physician, a PA, a nurse practitioner, or an experienced nurse or EMT. They would also get to assist with the work of the mobile clnic. We are looking for someone who could commit to staying for a significant period of time (close to a year or more). If you or anyone you know is interested, please let me know.